The Neuroscience of Being Human

The Neuroscience of Grief and Loss

How the brain processes the death of someone it was neurologically bonded to, why grief disrupts cognition, sleep, immunity, and the sense of self, and what the neuroscience reveals about a process that medicine has historically treated as either normal or pathological but rarely as neurological

The Neuroscience of Grief and Loss

944-word article with 8 Harvard references.

Key takeaways

  • The bereaved brain processes the loss of an attachment figure through multiple systems simultaneously: the reward system, which has lost a primary source of dopaminergic and oxytocinergic stimulation; the stress system, which is chronically activated by the absence of a co-regulator; the memory system, which continues to generate expectations of the deceased's presence; and the identity system, which must reconstruct a self-narrative that no longer includes the deceased in the present tense (O'Connor, 2019).
  • The brain's internal working model of the deceased persists after death, producing the continued expectation of their presence that is experienced as the hallmark of early grief. The brain continues to predict the deceased's arrival, their voice, their habits, and each time the prediction is violated by reality, the anterior cingulate cortex registers a prediction error that is experienced as a fresh wave of pain.
  • Grief disrupts sleep architecture, immune function, cardiovascular regulation, and cognitive performance. The bereaved show elevated cortisol, reduced natural killer cell activity, increased inflammatory markers, and impaired hippocampal function, producing the cognitive fog and physical vulnerability that characterise the first year of bereavement.
  • Complicated grief, in which the acute symptoms of bereavement persist beyond the expected timeline, is associated with sustained activation of the nucleus accumbens, suggesting that the reward system continues to be stimulated by reminders of the deceased, maintaining the attachment bond at the expense of adaptation.
  • The brain does not recover from grief by forgetting the deceased. It recovers by updating its internal model to accommodate the reality of absence while preserving the representation of the person in autobiographical memory. The process is not replacement. It is integration.

The brain that keeps expecting someone who is not coming back

The brain is a prediction machine. It builds models of the world and generates expectations based on those models, and when reality matches the expectation, the system runs smoothly, below conscious awareness. When reality violates the expectation, the anterior cingulate cortex registers the discrepancy, and attention is directed to the violation. This is what makes grief so relentlessly painful. The brain has spent years, sometimes decades, building a model of a world that includes the deceased. The model predicts their presence at the breakfast table. It predicts their voice on the phone. It predicts their breathing beside you in the night. And each time the prediction is generated, which is hundreds of times per day in the early weeks, reality violates it, and the anterior cingulate registers the violation, and the violation is experienced as pain.

Mary-Frances O'Connor at the University of Arizona has studied the neuroscience of grief more extensively than any other researcher, and her work illuminates the mechanism of this persistent prediction error (O'Connor, 2019). The brain does not immediately update its model when someone dies. The model was built over years of repeated experience and is maintained by the same long-term potentiation mechanisms that maintain any deeply learned pattern. The death does not erase the model. It creates a discrepancy between the model and reality that the brain must resolve through repeated encounters with the absence, each encounter providing the data that gradually, incrementally, painfully updates the prediction to accommodate the new reality. The process is not forgetting. It is learning, and what the brain is learning is the most difficult lesson any prediction machine can learn: that a pattern it relied on has permanently changed.

The body that grieves alongside the brain

Grief is not confined to the brain. The loss of an attachment figure, who served as a co-regulator of the stress response, produces systemic physiological consequences. The bereaved show elevated cortisol levels, reflecting chronic HPA axis activation. They show reduced natural killer cell activity, reflecting immune suppression. They show increased levels of inflammatory markers, including C-reactive protein and interleukin-6. They show disrupted sleep architecture, with reduced slow-wave sleep and increased nocturnal waking. And they show increased cardiovascular risk, with the phenomenon of broken heart syndrome, stress-induced cardiomyopathy, representing the extreme end of a spectrum of cardiac vulnerability that bereavement produces.

The physiological vulnerability of bereavement is not weakness. It is the body's response to the loss of a person who was, in a literal physiological sense, helping to regulate the systems that the bereaved person must now regulate alone. The partner whose presence reduced cortisol output through the buffering effects of oxytocin and social co-regulation is gone, and the systems they helped regulate must now self-regulate, and the self-regulation, in the acute phase of bereavement, is frequently inadequate, because the system was not designed to operate solo.

Invitation to reflect

If you are grieving, the neuroscience tells you something that well-meaning friends may not: this is not something you will get over. It is something you will get through, and the difference is important. Getting over implies that the grief will be resolved, that the pain will stop, that the person you lost will fade from your neural architecture. Getting through implies that the grief will be integrated, that the brain will update its model to accommodate the absence while preserving the representation of the person in memory, and that the pain will diminish not because you have forgotten but because the prediction errors have become less frequent as the brain has learned the new reality. The fog is real. The physical vulnerability is real. The sense that you are losing your mind is the subjective experience of a brain that is processing the most demanding form of neural updating it can undergo. Be patient with it. The brain is not broken. It is doing the hardest thing it has ever done: learning to live in a world that no longer contains someone it was built to expect.

References

  1. O'Connor, MF (2019) The grieving brain: the surprising science of how we learn from love and loss. New York: HarperOne.
  2. O'Connor, MF, Wellisch, DK, Stanton, AL, Eisenberger, NI, Irwin, MR and Lieberman, MD (2008) Craving love? Enduring grief activates brain's reward center. NeuroImage, 42(2), pp. 969–972.
  3. Shear, MK (2015) Clinical practice: complicated grief. New England Journal of Medicine, 372(2), pp. 153–160.
  4. Stroebe, M, Schut, H and Stroebe, W (2007) Health outcomes of bereavement. Lancet, 370(9603), pp. 1960–1973.
  5. Buckley, T, Sunari, D, Marshall, A, Bartrop, R, McKinley, S and Tofler, G (2012) Physiological correlates of bereavement and the impact of bereavement interventions. Dialogues in Clinical Neuroscience, 14(2), pp. 129–139.
  6. Gundel, H, O'Connor, MF, Littrell, L, Fort, C and Lane, RD (2003) Functional neuroanatomy of grief: an fMRI study. American Journal of Psychiatry, 160(11), pp. 1946–1953.
  7. Bonanno, GA (2009) The other side of sadness: what the new science of bereavement tells us about life after loss. New York: Basic Books.
  8. Hall, M, Buysse, DJ, Dew, MA, Prigerson, HG, Kupfer, DJ and Reynolds, CF (1997) Intrusive thoughts and avoidance behaviors are associated with sleep disturbances in bereavement-related depression. Depression and Anxiety, 6(3), pp. 106–112.

About the author

Gareth Strangemore-Jones, MHFA, DCST, PDPCP, HPD, DSFH, DMH, AHD, NCTJ, MSC-CPA, PGCE (FE) I & II

MNCPS (Reg.), MNCH (Reg.), MCNHC (Reg.), MAfSFH (Assoc.)

PSA (Acc.), FSE (Fellow), IFfS (Assoc.)

Mental Health First Aider, Pluralistic Counsellor, Clinical Psychotherapist. Consultant Medical Hypnotherapist, Mindfulness Teacher. PGCE-Trained Teacher, Lecturer, Corporate Trainer, Workplace Wellbeing Consultant. PR & Marketing Consultant, Psychology & Behaviour Advisor. Author, Journalist, Broadcaster. Advocate for Mental Health, People & Planet

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